The Truth about Statins

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What are statins?

Statins are a group of drugs developed to lower cholesterol levels by inhibiting the production of an enzyme (HMG-CoA reductase), which results in a decrease in cholesterol synthesis in the liver. Although initially thought to be a wonder drug, they have become the subject of much debate, regarding their relevance in lowering death rates from cardiovascular disease.

What they can do, and what they cannot do

When statins were launched in the 1980s, their ability to reduce total cholesterol and LDL (low density lipoprotein, also called “bad cholesterol”) was widely publicised, but it was subsequently discovered that they are not particularly effective in raising the levels of HDL (high-density lipoprotein, also called “good cholesterol”). Until the last few years, this was not cause for much concern, because the primary focus was on LDL as a cardiovascular risk factor. Recent research, however, has suggested that aggressively raising our levels of HDL (which acts as a vehicle for removing excess cholesterol from the circulation) may be much more valuable in reducing our risk than was previously thought, because HDL has emerged as an important independent risk factor for cardiovascular disease.

Statins may have benefits other than just lowering “bad” cholesterol. One promising benefit of statins appears to be their anti-inflammatory properties, which help stabilize the lining of blood vessels. This has potentially far-reaching effects, from the brain and heart to blood vessels and organs throughout the body, and is postulated to be a far more important benefit than its cholesterol lowering effect. In the heart, stabilizing the blood vessel linings would make plaques less likely to rupture, thereby reducing the chance of a heart attack. The level of inflammation in the blood vessels can be measured with the ultra-sensitive or high-sensitive CRP (hsCRP) level in the blood.

Statins also help relax blood vessels, thereby lowering blood pressure. In addition, statins could reduce the risk of blood clots. For these reasons, doctors are now beginning to prescribe statins before and after coronary artery bypass surgery or angioplasty, and following certain types of strokes.

Statins could also have benefits that help prevent diseases that aren't related to heart health, although more research is necessary. Other benefits of statins could include a reduced risk of:

  • Arthritis and bone fractures
  • Some forms of cancer
  • Dementia and Alzheimer's disease
  • Kidney disease

Statins may also be helpful in controlling the body's immune system response after an organ transplant.

Unwanted effects of statins

The first problem with statins as a whole group is their prevalence of unwanted side effects.

Muscle and joint aches, cognitive problems, peripheral neuropathy, or pain or numbness in the fingers and toes, are widely reported. A spectrum of other problems, ranging from blood glucose elevations, nausea, diarrhoea and constipation to tendon problems, can also occur as side effects from statins.

A review paper by Prof Beatrice Golomb published in 2009 cites 900 studies on the adverse effects of statins[1]. The paper provides clear evidence that higher statin doses or more powerful statins – those with a stronger ability to lower cholesterol – as well as certain genetic conditions, are linked to greater risk of developing side effects.

“Physician awareness of such side effects is reportedly low,” Golomb said. “Being vigilant for adverse effects in their patients is necessary in order for doctors to provide informed treatment decisions and improved patient care.” Other research shows patients who had definite or probable side effects tended to be dismissed by their doctors, who denied any specific statin-linked side effects and failed to appreciate the effect on their life.

A Dutch survey of 4,738 statin users asked the users about side effects. Just over a quarter (27%) said they suffered from them. Around 40% of these sufferers experienced muscle pain and almost a third (31%) had joint pain. It also reported that 16% had digestion problems and 13% had memory loss.

The cause of side effects

There is powerful evidence that statins cause injury to the functioning of the mitochondria (body’s energy-producing structures within cells), and this underlies many of the adverse effects that occur to patients taking statin drugs[1].

Mitochondria produce most of the oxygen free radicals in the body, which are harmful compounds that antioxidants seek to protect against. When mitochondrial function is impaired, the body produces less energy and more free radicals are produced. Coenzyme Q10 (CoQ10) is a compound central to the process of making energy within mitochondria and quenching free radicals. However, statins lower CoQ10 levels because they work by blocking the pathway involved in cholesterol production – the same pathway by which CoQ10 is produced. Statins also reduce the blood cholesterol that transports CoQ10 and other fat-soluble antioxidants.

The loss of CoQ10 leads to loss of cell energy and increased free radicals which, in turn, can further damage mitochondrial DNA (genetic material in cells). Because statins may cause more mitochondrial problems over time – these energy powerhouses tend to weaken with age — new adverse effects can also develop the longer a patient takes statin drugs. This also helps explain why the benefit of statins have not been found to exceed their risks in those over 70 years old, even those with heart disease. High blood pressure and diabetes are linked to higher rates of mitochondrial problems, so these conditions are also clearly linked to a higher risk of statin complications. As these conditions commonly occur together in the same patient, the chances of problems are increased in these individuals.

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